Charles D. F. (Charles Douglas Fergusson) Phillips.

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frequently causes abscess.

Corrosive Sublimate. The absorption of corrosive sublimate may be
realized without much difficulty, because it is soluble in ordinary fluids;
an albuminate of mercury may form in the stomach, but is probably not
absorbed as such: the formation of a double salt with sodium is more
likely, and the same occurs with iodides and bromides of mercury: saline
or albuminous solutions of perchloride and aqueous solutions of cyanide
are also readily absorbed from the cellular tissue.

The chlorides and iodides may also be absorbed from blistered surfaces
(endermic method), and probably then also, double salts with albuminous
and alkaline constituents of the serum are formed.

Elimination. Although we cannot state positively the form in which
mercury circulates or is deposited within the system, whether in a vola-
tile form at first, or as very finely divided metal, or oxide, or as an albu-
minate, or (which is more probable) as a double chloride with soda or



MERCURY. 191

ammonium and albumen, yet we can be satisfied of its detection under
certain circumstances, in every organ, and in every secretion. With the
blood it seems so closely associated, that destructive distillation is usually
required for its detection, and in the milk, and even in the urine, there
has been difficulty in finding it, so that some observers have reported
against its presence (Kohler: Practitioner, vol. xvii. ; Cullerier: British
and Foreign Review, ii., 1852), but the more modern researches of Per-
sonne, Binz, Hamburger, and others, can leave no reasonable doubt on
the subject. Heller detected mercury in the foatus borne by a salivated
mother, and in the urine of an infant whose nurse was taking calomel.
Sometimes, however, it may not be discovered after inunction, though
readily after the use of mercurial suppositories (Prag. Med. Wbch., iv.,
1877; Lancet, ii., 1877). (The modern and accurate. method of detecting
mercury is by electrolysis.)

The question of its elimination by the milk is one of much impor-
tance, for large establishments have been formed in Paris for the treat-
ment of syphilitic infants especially, through the milk of nurses or of
goats that have taken mercury: such treatment is constantly adopted
with good result, and there is abundant clinical evidence of its value.
With regard to the time during which mercury remains in the system, it
is ascertained that of a single dose elimination is rapid, and is apparently
completed within twenty-four hours; for -J- gr. of perchloride having been
taken, the urine contained traces for that period, but not afterward; and
.075 gramme (about 1 gr.) having been injected under the skin of a rab-
bit, none could be discovered in any part of the body four days after-
ward (Mayen9on and Bergeret: Robin's Journal of Anatomy, No. 1;
Lancet, i., 1873). M. Byasson injected \ gr. of sublimate under his own
skin, and found mercury in the urine two hours afterward, and at the
end of four hours in the saliva, but after twenty-four hours he detected
no more. If treatment have been continued for some time, mercury may
be found in the urine for several days afterward; thus, in the urine of two
patients who took ^ gr. daily for ten to twelve days, the drug was found
for four or five days after treatment had been omitted.

During a mercurial course, the greater part of the drug is eliminated
almost as soon as taken, but some remains in the tissues and passes out
insensibly; and when the doses have been large and long-continued,
some may be retained in the organism for months or even for years. It is,
in fact, impossible to recognize exactly when its elimination is complete,
though it is probably not so prolonged as that of gold, lead, or silver
(Husemann). Years after its prolonged administration, unusual perspi-
rations may develop dark mercurial stains on the linen, or a white coat-
ing be given to a piece of copper on handling it (W. Pope, quoted by
Stille). Salivation may reappear without apparent cause (unless a chill);
sometimes it has been traced to the use of sulphurated mineral waters,



192 MATEKIA MEDICA AND THERAPEUTICS.

and occurred in one patient ten years after taking 1 the medicine (Har-
tung, quoted by Hallopeau). I have myself seen five patients, while
under the influence of nitric acid, suffer from salivation and other physi-
ological symptoms of mercury, and none of these had taken that drug
for over eighteen months previously: I considered it clearly traceable to
the mercury in the system, and not to the acid. The metal has been
found in the liver of a workwoman who had not, for twelve months pre-
viously, been exposed to mercurial vapors, and in the liver and kidneys
of another who died of phthisis six months after leaving her work at a
mirror factory (Kussmaul, Gorup Besanez: Wien, Med. Wbch. y 1SG2).

Melsens pointed out (1844) that iodide of potassium favored the elim-
ination of mercury as well as of lead, and in many cases it has been found
that elimination, which had ceased, has been renewed under the influence
of the iodide; yet this influence is not always sufficient to complete the
process, for Kussmaul found a quantity of mercury in the viscera of a
patient who had taken none for four months, and who, in the course of a
month, had taken 2 oz. of the iodide.

Riederer has made experiments to ascertain the quantity of mercury
that may be found in different organs or secretions: of about 10 gr. of
calomel given to a dog in thirty-one days, he recovered four-fifths the
largest proportion from the faeces, the next from the urine, the liver, the
thoracic viscera and brain, and the least from the muscles (quoted by Hal-
lopeau, p. 58). Other observers agree that on section of an animal sub-
jected to the action of mercury, the largest amounts are found in the
liver and kidneys (and not in consequence of their containing more blood
than other viscera, for the blood contained a much less proportion of the
drug); it must therefore be considered to have a special determination
to the liver and kidneys, and it is eliminated mainly by the bile and the
urine; in this respect it resembles other metals.

PHYSIOLOGICAL ACTIOX (EXTERNAL). The local action of mercury
varies according as to whether the metal itself is used, or one of its solu-
ble or insoluble compounds, and of course according to the strength of
the preparation; and on account of the volatility and the ready absorp-
tion of the drug, its local use often induces its systemic effects.

Metallic mercury produces upon the skin no other local effect than a
sense of coldness. Mercurial ointment applied by friction is usually well
borne, but sometimes excites a red or vesicular eruption (mercurial ecze-
ma), more or less intense; ointment of the red oxide is painful to sen-
sitive parts, and that of the red iodide may irritate very severely, even
to vesication: if not perfectly fresh an additional source of irritation is
found in rancid lard: good calomel ointment is rather soothing than
otherwise.

A strength of 2 gr. of corrosive sublimate in the ounce of liquid suf-
fices to destroy parasitic life; a stronger lotion irritates. Cloquet, the



MERCURY. 193

distinguished anatomist, suffered from severe local and general symptoms
after handling some preparations steeped in a strong solution. A pro-
portion of 10 gr. to the drachm of alcohol vesicates, and when applied to
the scalp has caused death in a child (J^ancet, ii., 1871). In two other
children, the use to the scalp of an ointment containing 120 gr. to the
ounce of tallow also caused death (Dublin Journal, August, 1854). The
solution of the metal in nitric acid (liquor hydrargyri nitratis acidus) is a
powerful and painful caustic, and its application has sometimes, thougli
not frequently, been followed by severe general symptoms: it combines
with albumen and fibrine, producing a white eschar.

On the mucous membrane of the intestinal tract mercurial compounds
may exert a local action of the same nature as upon the skin. Quicksil-
ver, in doses of oz. or more, will usually pass through the intestine by
its mechanical weight, and unaltered; sometimes it has caused perforation.

PHYSIOLOGICAL ACTION (INTERNAL). In studying the action of this
medicine, it is more than usually important to distinguish between the
effects of small and of large doses. Modern observation shows us that
the former are rather of tonic and constructive character, while older
records have told us only too well the fatally destructive results of the
" heroic " administration of the drug. I do not mean simply that one
grain, e.g., of calomel has a different effect from twenty: we must esti-
mate the dose rather by what is absorbed of it, and by the results shown,
especially by the state of the mouth and the secretions. Practically we
can either give the medicine so as to cure without marked effect upon
these, or so as to produce only moderate effects, and it is this "slight
mercurialization" which requires to be distinguished from the severe form
which should be called rather mercurial poisoning, and is accompanied
with stomatitis, salivation, diarrhoea, cachexia, etc. A similar difference
of degree exists, of course, in the action of all powerful medicines, but it
requires more attention in the present instance, because our predecessors
thought to give benefit only by what we consider a poisonous action of
the drug,^and it consequently fell into undeserved discredit. There is,
further, a chronic form of mercurial poisoning which may still be met
with in various trades, and this differs in some respects from any condi-
tion produced by modern medication.

Circulatory System. Recent observations as to the action of mercury
on the blood illustrate well its different effects, since they show that, in
quite small doses, it increases the number of red corpuscles, and improves
the blood-condition. Grassi proved this by analyses, and Wilbouchewitz
counted carefully under the microscope the average number contained in
a millimetre-cube, and his patients (ten in number) then took either gr.
of sublimate daily, or ^ gr. of proto-iodide: during the first fortnight of
treatment the increase of corpuscles amounted to nearly one million.

These patients were syphilitic, and probably the anaemia of their
VOL. II. 13



194 MATERIA MEDICA AND THERAPEUTICS.

malady was benefited by the antidotal action of the mercury, for the remedy
being continued beyond a certain time (and thus allowed to accumulate
in the blood), the red globules diminished in number, so that, by the end
of the second fortnight, they counted the same as before any treatment.
Mercury being then omitted altogether, the corpuscles increased again
within a week's time. The inference is clear too much of the drug im-
paired the blood-condition, but a little improved it. When it was omitted,
and when, after a few days' time, only a small proportion remained in the
blood, the original improvement was again observed: the white globules
varied in an inverse ratio (Archives de Physiologie, 1874). Keyes repeated
these observations, and concluded that small doses of mercury increase
the blood-corpuscles in all subjects, whether syphilitic or not; and further,
that this increase is not temporary: he has never seen hypoglobulism
i.e.) a lessened average number of corpuscles, caused by small doses
(American Journal, January, 187G). Possibly the difference between
these two observers may arise from difference in dosage, Wilbouchewitz
giving the rather large quantity of " gr. sublimate daily;" no doubt
mercury in any form, continued long enough, and absorbed, will produce
a. destructive effect on the corpuscles, and a condition of "spansemia."
Long ago, Bretonneau and Dumont reported that the blood-clot in mer-
curialized animals was either absent or was soft and diffluent. Headland's
expression is that mercury " disintegrates and decomposes the blood "
(Lancet, i., 1858), and Wright's analysis showed it to be more fluid and
less coagulable than normal, its albumen, fibrine, and red globules being
diminished, and a foatid, fatty material being formed in it. Gubler has
also corroborated this destructive effect, and yet Lemaire and Gelis found
"mercurial treatment to increase plasticity of blood." Autenrieth ques-
tions the analysis of Wright, and more lately Overbeck found in animals
poisoned by mercury the venous blood dark and thick, the arterial blood
clear and coagulating well, fibrine increased: probably these results were
connected with inflammatory reactions, but, if verified, they tell much
against any available " aplastic power" of mercury in inflammation;
still, the ultimate effect of the drug is destructive. Polotebnow, adding
mercurial albuminate to the blood of dogs, found the corpuscles rapidly
destroyed, with loss of hjematine and pigment (Schmidt's Jahrb., 1865,
125, 3). Wilbouchewitz, giving calomel to rabbits (and not in large
doses), noted a rapid diminution of corpuscles. Trousseau found that
leech-bites that had ceased bleeding, bled again in patients submitted to
mercurial treatment, but beyond any single fact is the general expe-
rience that too much of the drug induces after a period of malaise,
restlessness, and febrile symptoms a chlorotic pallor of the skin, with
signs of enfeebled circulation, distress in breathing, intermittent pulse,
and palpitation; such a condition, when fully developed, is difficult of
cure; it may last long, and end fatally.



MERCURY. 195

Fothergill includes mercury among his "cardiac depressants," and G.
Harley, having injected sublimate into the femoral vein of a dog, found
that cardiac paralysis was produced before intestinal contractions ceased
("Proceedings of the Royal Society," 1864).

Nutrition. Nutrition is so closely connected with haematosis that we
shall be prepared for the modern observations that it also may be improved
by small doses of mercury. Keyes found this to be the case the weight
of his subjects increased under their course, and the remedy acted "as a
tonic." Hufeland had previously made a similar observation, and Basset,
Liegeois, and others corroborate it: the last-named observer considers
sublimate in minute doses "comme un rc'constituant des plus puissants "
(Annales de Dermatol., i., ii., 1870), and M. Clerc reports the same ex-
perience (Gazette de Paris, 1872, p. 481): it has been verified also, inde-
pendently of syphilis, on animals, and especially rabbits.

On the important question of urinary excretion the principal evidence
is negative. We need more research in this direction, but so .far the
evidence does not favor the theory of mercury (in small doses) curing
disease by increase of tissue-change that it lowers the temperature in
animals (except during the stage of " erethism "), and that it does the
same in fever (Wunderlich), I should take as evidence of its lessening
change, rather than the contrary, as Husemann does. Altogether, at
least in the doses under consideration, mercury merits the name of
"moderator of nutrition," rather than of alterative (Rabuteau); and in
this role we can see its analogy with small doses of arsenic, antimony, etc.,
under which, as is well recognized, weight may be gained, and nutrition
improved. Under full or poisonous doses, when the blood-corpuscles are
destroyed, the secretions are rendered profuse, and digestion impossible,
nutrition is, of course, profoundly impaired, and waste of tissue progres-
ses most rapidly.

Digestive System. Small (therapeutical) doses of any preparation are
usually well borne by the stomach. Rabuteau cites cases where many
hundred pilules of proto-iodide have been taken in the course of one to
three years without any gastric disturbance: yet we must allow for some
idiosyncrasy in this respect, and practically we find that those who have
resided long in the tropics, and fair, delicate women and chronic dyspep-
tics are very sensitive. It is not, however, possible to say beforehand
what amount of mercury will produce the characteristic effects on any
given case a single friction or a few grains may produce in one patient
what many weeks of treatment will not do in another. Single doses of
calomel from 1 to 5, 10, or even more grains produce thin and " bilious "
stools without much griping. If the intestine of an animal be examined
after such actions, it will be found reddened, especially in the upper part,
and its glands stimulated. As a rule, ordinary care will early detect
symptoms of constitutional action in the mouth, such as a sense of heat,



19C MATERIA MEDIC A AND THERAPEUTICS.

metallic taste, sticky coating of the tongue, increased flow of saliva, and
perhaps slight tenderness of the gums. On continuance of the medicine,
these latter symptoms increase and diarrhoea occurs, with some nausea.
The stools, at first feculent, become thin and sometimes papescent with
mucus, sometimes yellow, or dark or grass-green (the latter especially in
children: they have been compared to " chopped spinach"): sometimes
blood appears in the motions, and severe colic and tenesmus occur. The
tongue is said to show a greenish coating with two longitudinal red
stripes (Traube). In severe cases, when the poisonous action of mercury
has been induced, intense stomatitis appears, with swelling of the tongue
and gums, membranous deposit, fetor, loosening of teeth, and severe pain
and difficulty in mastication. The salivary glands become enlarged and
tender, and a vast amount of secretion pours from the mouth: 10 Ibs. of
it have been secreted in twenty-four hours: at first viscid as usual, it soon
becomes thin and very watery, containing albumen, mucus, and alkaline
chloride (Thompson). Children and the aged are seldom salivated
Graves suggests because their salivary glands are " inapt " diarrhoea or
prostration is with them the earliest symptom. Salivation is connected,
too, with local causes: it comes on more quickly when the mouth is un-
clean, and may be almost wholly prevented by great care with the teeth:
dental caries will determine it; it is said to commence by the last molar
of the side on which the patient mostly sleeps (Ricord): also the irritation
of a wisdom-tooth, or of a pipe, will influence it.

Such fajts have led to the supposition that salivation is only second-
ary to buccal soreness, but this is incorrect: it may be induced by rub-
bing mercury over the parotid, and before any irritation is produced.
Ricordi detected the drug in saliva drawn from Steno's duct, by a cathe-
ter, in animals, when calomel had been injected beneath the skin; and
salivation occurs, as we know, independently of mouth-irritation from the
action, e.g., of gold, iodine, various acids, etc., as well as during preg-
nancy and certain diseases. The safe test of a mercurial salivation is de-
tection of the metal in the secretion. Women seem to be more readily
affected in this way than men, and the subjects of granular kidney, of
scrofula, and of scorbutus are peculiary susceptible (Christison and
others). It occurs more frequently under fractional (non-purgative) doses
of calomel, or inunction of blue ointment, than from fumigation, supposi-
tories, or injections: it is markedly less under the use of sublimate,
iodide, or cyanide, than of insoluble preparations, either on account of
the smaller dose of the former employed, or of some peculiarity in their
elimination. Ulceration, or sloughing of the gums, hemorrhage, periosti-
tis, and prostration of even fatal character have occasionally followed a
profuse salivation, and necrosis, scars, and contractions have accompanied
even recovery.

We have seen that a local action, irritant in character, is exerted by



MERCURY. 197

most compounds of mercury on the alimentary tract; but IT. Wood
speaks of calomel as "free from all irritant properties," and Lente ar-
gues that large doses (one teaspoonful) act in a sedative manner (New
York Journal, 1870, vol. xi.) this was the argument of Annesley, but it
is not a safe one to act upon. The irritation excited by corrosive sublimate
in toxic doses is, however, the most severe: there is an acrid taste, and a
sense of burning and constriction in the mouth and fauces, with whiten-
ing and shrivelling of mucous membrane if the dose be concentrated:
vomiting and purging with tenesmus usually occur, with passage of blood,
suppression of urine, and general symptoms of gastro-enteritis: after
death, signs of inflammation, contraction, or ulceration have been found,
especially in the stomach and upper part of the intestine, and that this
is not merely a local effect is proved by its occurrence when the drug
has been administered by the skin. Profound depression is usually a
symptom of sublimate poisoning, and is sometimes more marked than
pain, vomiting, or purging; salivation is by no means constant in acute
cases.

The iodides of mercury act much like corrosive sublimate, the red
iodide being more actively irritant than the -green one. The red oxide
produces similar lesions of the intestinal canal (Orfila); it is not given in-
ternally in medical practice, nor is the ammonio-chloride (white precipi-
tate), but in a case when a large quantity of the latter compound caused
death, the stomach was found contracted, and its lining membrane ecchy-
inosed (Guy's Reports, 1874). The liquor hydrargyri nitratis has pro-
duced intensely severe effects on the intestinal tract, and irritant poison-
ing has followed the accidental use of the sulphides and the cyanide of
mercury.

Glandular System, Liver, etc. Most of the glandular organs are lia-
ble to become congested, and stimulated under the influence of mercury.
This has been noted not only of the salivary glands as already described,
but also of the pancreas and intestinal glands, the kidneys and the liver,
the testis and lymphatic glands of axilla and groin (C. II. Jones: Medico-
Chirurgical Transactions, vol. xxxv., etc.). As illustrating the effect
on the pancreas, Dr. Copland recorded a case, where, in addition to sali-
vation, deep-seated epigastric pain set in, with nausea and diarrhoea of
thin fluid resembling saliva; after death the gland was found large and
congested. Radziejewski found, on analyses of the stools after giving
calomel, a large proportion of leucin, tyrosin, and indol (pancreatic secre-
tion), which he did not find after other purgatives (Reichert's Archiv,
1870). That calomel also stimulates the intestinal glands has been de-
monstrated by Rutherford.

The mode of its action on the liver is still a subject of discussion, and
the conclusions of some physiologists on this subject are opposed to those
of many practical physicians. Up to a recent period, mercury was uni-



198 MATERIA MEDICA AND THERAPEUTICS.

versally regarded as a typical " cholagogue," in the sense of its stimulat-
ing both the secretion and the excretion of bile, and hence was commonly
employed, both in cases of deficient secretion to stimulate, and in cases
of excessive secretion to " carry off " the excess.

The early experiments of Murray were taken to corroborate the theory
of "cholagogue" action, for, after giving purgative doses of calomel to
dogs, he found increased discharge of bile, mucus, and serum from the
bowels (quoted by Morehead, 1841). Buchheim also reported an increase
in the amount of bile discharged by dogs with biliary fistulas. Still more
important evidence was furnished by the analyses of Michea, which were
made first upon the normal stools of six healthy subjects without detect-
ing bile; then, with nearly like result, upon the green stools of persons
suffering from diarrho3a; then upon the greenish motions which occurred
in eight healthy persons after taking calomel, and in all of which bile
was clearly detected; and lastly, upon discharges produced by different
saline and resinous purgatives, and in which no bile was found (Lancet,
i., 1849). Although these observations show an increased discharge of
bile under calomel it is clear that they do not necessarily prove an in-
creased secretion by the liver-cells, and therefore experiments on animals
as to this point were undertaken. Kolliker and Miiller, after giving cal-
omel to dogs with biliary fistulse and collecting the bile discharged, report-
ed contradictory results the secretion being in one instance increased,
while in two others it was diminished (1855). Scott, experimenting with
large doses of calomel on four dogs (also with fistulse), recorded diminu-
tion of both fluid and solid biliary constituents in all the animals (Beale's
Archives, i., 1858). Mosler, with two dogs, obtained a similar result



Online LibraryCharles D. F. (Charles Douglas Fergusson) PhillipsMateria medica and therapeutics, inorganic substances; (Volume 2) → online text (page 24 of 40)